sunshine health florida claims address
Sunshine Health P.O. Attn: LTC Reconsideration If you are not already registered, create a new account by registering at payspanhealth.com/ or call 1-877-331-7154. Review and retain a copy of the error report that is received for claims that have been submitted electronically, then correct any errors and resubmit with your next batch of claims. 4.Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from Sunshine Health has on record (To view your address of record, please log on to Ambetter.SunshineHealth.com or call Member Services at 1-877-687-1169 (Relay Florida: 1-800-955-8770) For questions on specialty drugs, call 1-866-796-0530. Box 31370 Tampa, FL 33631-3370, WellCare Health Plans How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, updates for Screening, Brief Intervention and Referral to Treatment (SBIRT), SunshineProviderRelations@Sunshinehealth.com. " Sunshine waives any dispute not raised within 21 days," the government had warned the company March 17. It is important that providers ensure Sunshine Health has accurate billing information on file. We want your claim submissions processed as efficiently as possible. Your inquiry will be reviewed. Please fill out the below form or contact us at 1-866-796-0530 . Quick Links PRE AUTH CHECK SUBMIT CLAIM/CHECK CLAIM STATUS TRAINING Become A Provider Provider News Show Do you need more information or have a question? Provider Town Halls cover a variety of post-integration updates to better assist you in navigating our processes. These plans require a referral to see specialists. When Sunshine Health is the secondary payer, Sunshine Health must receive the claim within ninety (90) days of the final determination of the primary payer. Updates to such Medicaid fee schedules (for all provider types and in any form, including but not limited to, Medicaid Bulletins) shall become effective on the date (Fee Change Effective Date) that is the later of: (i) the first day of the month following thirty (30) days after publication by AHCA of such fee schedule updates, or (ii) the effective date of such fee schedule updates as determined by AHCA. For more information contact the Managed Care Plan. Please submit this information on a W-9 form. Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770) Please confirm with your Provider Relations Department that the following information is current in our files: Providers must bill with their NPI number in box 24J of the HCFA 1500 if applicable. Sunshine Health uses an imaging process for claims retrieval. You will need Adobe Reader to open PDFs on this site. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Contact Provider Services, 8 a.m. to 8 p.m. Monday-Friday, at 1-844-477-8313 with questions or assistance with the following services: . Farmington, MO 63640-3823 How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, Provider National Provider Identifier (NPI), Physical location address (as noted on current W-9 form), The Enrollee is effective on the date of service, The service provided is a covered benefit under the Enrollees contract on the date of service, Referral and prior authorization processes were followed, If you are the provider for a Sunshine Health Enrollee and receive a monthly capitation amount for services, you must file a proxy claim (also referred to as an. You will need Adobe Reader to open PDFs on this site. As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Providers needing personal assistance can call Sunshine Health: Medicaid/Healthy Kids: 866-796-0530 Child Welfare: 855-463-4100 Ambetter: 877-687-1169 Medicare: 877-935-8022 Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . . Your billing department will need to submit to the appropriate payer to prevent payment delays. Mechanical or administrative delays or errors by Sunshine Health or AHCA. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Always bill the primary diagnosis in the first field. Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. If you are a contracted Sunshine Health provider, you can register now. 08/31/21. Call Provider Services at 1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. transaction. Such claims are not considered clean and therefore cannot be entered into the system. Your inquiry will be reviewed. The benefit information provided is a brief summary, not a complete description of benefits. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Questions regarding this update can be emailed to SunshineProviderRelations@Sunshinehealth.com. Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. Member Services: As of Sept. 23, 2023, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. Use this form as part of the Ambetter from Sunshine HealthRequest for Reconsideration and Claim Dispute . Contact Us There are five easy steps to submitting a claim. We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS), the Florida Department of Health (DOH), the Agency for Health Care Administration (AHCA), and all other applicable agencies as it is released to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. Please register in advancespace is limited. If you have a life threatening emergency, please contact 911. Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. Members call any time to reach our 24-hour Nurse Advice Line. Medicare crossover claims must be submitted within 90 days after final determination of the primary payer which is not to exceed 3 years from the date of service. There are no changes, as PaySpan Health will continue to be the provider of Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) free solutions. A Sunshine Health representative may contact you regarding your inquiry. Box based on date of service guidance below. The state is giving Sunshine 30 days to pay the fine. Your inquiry will be reviewed. Qualifying circumstances include: Consideration is granted in this situation only if all of the following conditions are met: When submitting a paper claim for review or reconsideration of the claims disposition, a copy of the EOP must be submitted with the claim, or the claim must clearly be marked asRE-SUBMISSION and include the original claim number.Failure toboldlymark the claim as a resubmission and include the claim number (or include the EOP) may result in the claim being denied as a duplicate, or for exceeding the filing limit deadline. You are required to submit an encounter or claim for each service that you render to a Sunshine Health Enrollee. BOX 3070 Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. Providers must submit, all claims and encounters within 180 days of the date of service, unless Sunshine Health or its vendors created the error. Read provider coronavirus guidance. Sunshine State Health Plan For more information on electronic filing, contact: Sunshine State Health Plan c/o Centene EDI Department 1-800-225-2573, extension 25525 . Register for FREE training to treat Opioid Use Disorder (OUD) and qualify for the waiver to prescribe buprenorphine. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). The benefit information provided is a brief summary, not a complete description of benefits. Right now, nothing is changing. Services rendered from 2021 forward will be paid at the currentCDC vaccination rate. P.O. Member Services: As of October 27, 2022, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. . Contact Us Florida Medicaid Sunshine Health. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). A Sunshine Health representative may contact you regarding your inquiry. (Just Now)Sunshine Health P.O. If you have any questions, please contact the EDI Department at the email address below. For more information contact the Managed Care Plan. Get medical help from doctors via video and phone. Sunshine Health will return claims when billing information does not match the information that is currently in our files. . For more information on electronic filing, contact: Sunshine State Health Plan Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . The plan has the capability to receive an ASC X12N 837 professional, institution or encounter. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Get covered with Sunshine Health today. If you are a non-contracted provider, you will be able to register after you submit your first claim. All disputed claims will be processed in compliance with the claims payment resolution procedure as described in this Provider Manual. The benefit information provided is a brief summary, not a complete description of benefits. Limitations, co-payments and restrictions may apply. Members call any time to reach our 24-hour Nurse Advice Line. Category: Health View Health Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed care plan with a Florida Medicaid contract. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . It was alleged that the experiment tripled the whooping cough infections in Florida to over one . The filing limit may be extended for newborn claims, and where the eligibility has been retroactively received by Sunshine Health, up to a maximum of 365 days. . A clean claim means a claim . We recommend that providers notify Sunshine Health in advance of changes pertaining to billing information. For more information contact the Managed Care Plan. For more , https://www.sunshinehealth.com/providers/resources/electronic-transactions/ltc-claims-submission.html, Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Limitations, co-payments and restrictions may apply. Your inquiry will be reviewed. Pending or retroactive Enrollee eligibility. For more information contact the Managed Care Plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Contact Us Florida Medicaid Sunshine Health Health Please fill out the below form or contact us at 1-866-796-0530 . Get covered with Sunshine Health today. All requests for reconsideration or adjustment to paid claims must be received within 90 calendar days from the date the notification of payment or denial is received. Molina Healthcare: 1-855-322-4076 or MFLProviderServices@MolinaHealthcare.com Staywell: 1-866-334-7927 or MLTCproviders@wellcare.com Sunshine Health: 1-866-796-0530 or Sunshine Health HHAeXchange: FLsupport@hhaexchange.com WellCare Health Plans See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Claims will not be denied based solely on the period between date of service and the date of clean claim submission unless that period exceeds 365 days. Centenes acquisition of WellCare's Medicaid products, including , https://www.sunshinehealth.com/newsroom/Guidelines-for-proper-claims-submissions.html, Health (1 days ago) Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your inquiry will be reviewed. Ambetter from Sunshine Health Attn: Claim Disputes PO Box 5000 Farmington, MO 63640-5000 Complaint/Grievance A Complaint/Grievance is a verbal or written expression by a provider which indicates dissatisfaction or dispute with Ambetter's policies, procedure, or any aspect of Ambetter's functions. Sunshine Health MMA: 1-866-796-0530 (TTY 1-800-955-8770) Sunshine Health Child Welfare Specialty Plan: 1-855-463-4100 (TTY 1-800-955-8770) Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . Sunshine Health Claims Mailing Address. Florida's largest Medicaid managed care plan paid a $9 million fine this week for failing to pay, or to timely pay, 121,227 claims from health care providers. All requests for reconsideration or adjustment to paid claims must be received within 90 days from the date the notification of payment or denial is received. A Sunshine Health representative may contact you regarding your inquiry. Contact Us Florida Medicaid Sunshine Health. Download the free version of Adobe Reader. Failure to follow these instructions may result in eligibility rejections. The errors or omissions in claims result in the request for additional information from the provider or other external sources to resolve or correct data omitted from the bill; review of additional medical records; or the need for other information necessary to resolve discrepancies. Starting Feb. 1, 2021, Sunshine Healthrequires hospital providers to use inpatient type of bill code 0112 interim when billing first-time claims for interim inpatient stays that exceed 100 consecutive days. Register for OUD Training. Copies of claim forms will not be accepted. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed , https://www.sunshinehealth.com/providers/Billing-manual.html, Health (5 days ago) Guidelines for proper claims submissions effective Oct. 1, 2021. Austin . Do you need more information or have a question? Sunshine Health Claims Mailing , https://www.health-improve.org/sunshine-health-medicaid-claims-address/, Health (1 days ago) Provider Services: 1-877-935-8022 (TTY: 711) From October 1 March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 September 30, you can call us , https://wellcare.sunshinehealth.com/contact-us.html, Health (6 days ago) Contact Us Florida Medicaid Sunshine Health. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. This joining of our organizations will allow us to become a more robust health plan and enhance the delivery of best-in-class care to our members. If you must submit paper claims, you must mail to the appropriate payers P.O. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . Ambetter can help. For Sunshine Health Enrollees, all claims and encounters should be submitted to: Sunshine State Health Plan If you must submit paper claims, you must mail to the appropriate payer's P.O. Sunshine Health is a managed care plan with a Florida Medicaid contract. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Members on our Value Plans can receive services from any Primary Care Provider in the CMG network, which can be found using our Ambetter guide. Box 31368 Tampa, FL 33631-3368. When submitting claims where other insurance is involved, a copy of the EOB or rejection letter from the other insurance carrier must be attached to the claim. Crime Statistics for Sarasota County, . Providers that bill electronically are responsible for filing claims within the same filing deadlines as providers filing paper claims. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. (EOP). Sunshine State Health Plan Inc. of Tampa had until 5 p.m. Thursday to dispute the large fine imposed last month by its government regulator, the Agency for Health Care Administration, leaving the company with only the option to concede to pay. NBC4 WCMH-TV Watch NBC4 Daytime Columbus NewsNation Stream NBC4 newscasts live TV Schedule NBC Shows Watch NBC Sports Laff Ion Television GUIDE: How to watch NBC4 on streaming services Weather Live VIPIR Radar Storm Team 4 Forecast Closings Weather Alerts Storm Team 4 Weather Alert Days Weather History Climate Columbus Athens Weather Chillicothe Weather Lancaster Weather Marion Weather Newark . Title . To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. We have dedicated Provider Relations Representatives located in offices across Florida. Find your representative. or by e-mail at: Any prior underpayments will be reprocessed automatically. Required fields are marked with an asterisk (*) For participating providers who have internet access and choose not to submit claims via Electronic Data Interchange (EDI), Sunshine Health has made it easy and convenient to submit claims directly to us on our website atwww.sunshinestatehealth.com. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Healthcare is essential. The QRGs include targeted claims and authorization instructions per provider type. Centenes acquisition ofWellCare'sMedicaid products,includingStaywellHealth Plan, will be completeOct. 1, 2021. Approved adjustment will be processed in compliance with the proper provider NPI and Tax Can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770. Authorization or referral, MO 636404401 see if you & # x27 ; s P.O providers Tax Identification Number address. 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